How should I manage a patient with septic arthritis who has underlying comorbidities such as diabetes or immunosuppression?

Management of a patient with septic arthritis and comorbidities such as diabetes mellitus or immunosuppression involves urgent hospital admission and specialist care. This is because such patients are at higher risk of severe infection and complications, requiring intravenous antibiotics and possibly surgical intervention.

Immediate referral or admission is recommended if septic arthritis is suspected, especially with limited joint movement and systemic signs of infection. Patients with diabetes or immunosuppression should be considered for hospital admission even if symptoms are less severe, due to their increased vulnerability.

Antibiotic therapy should be initiated promptly, with intravenous administration preferred in severe cases or if the patient is systemically unwell. The duration of antibiotic treatment may need to be extended beyond the usual 10–14 days, particularly in immunocompromised patients, and specialist advice should be sought for tailoring therapy.

Joint aspiration for diagnosis and therapeutic drainage is essential, and repeated aspiration may be considered if expertise is available and infection persists. Surgical drainage may be necessary if there is a pointing abscess or inadequate response to antibiotics.

Management of underlying comorbidities, such as optimizing glycaemic control in diabetes, is important to improve outcomes.